RESUMEN
Introduction: Recent evidence indicates that respiratory distress (RD) in near-term infants is caused by elevated airway liquid (EL) volume at the beginning of air-breathing after birth. While the adverse effects EL volumes on newborn lung function are known, the effects on respiratory control and breathing patterns shortly after birth (<4â h) are unknown. We investigated the effects of EL volumes on cardiorespiratory function and breathing patterns in spontaneously breathing near-term newborn lambs in the first hours after birth. Methods: At 137-8 days gestation (2-3 days prior to delivery; term â¼147 days), sterile surgery was performed on fetal sheep (n = 17) to implant catheters and blood flow probes. At 140 days, lambs were delivered via caesarean section under spinal anaesthesia. Airway liquid volumes were adjusted to mimic the level expected following vaginal delivery (â¼10â ml/kg; Controls; n = 7), or elective caesarean section (â¼30â ml/kg; elevated airway liquid group; EL; n = 10). Spontaneous breathing and cardiorespiratory parameters were recorded over four hours after birth. Non-invasive respiratory support with supplemental oxygen was provided if required. Results: EL lambs required higher inspired oxygen levels (p = 0.0002), were less active (p = 0.026), fed less (p = 0.008) and had higher respiratory morbidity scores than Controls (p < 0.0001). EL lambs also displayed higher rates of breathing patterns associated with RD, such as expiratory braking and tachypnoea. These patterns were particularly evident in male EL lambs who displayed higher levels of severe respiratory morbidity (e.g., expiratory braking) than female EL lambs. Conclusion: The study demonstrates that EL volumes at birth trigger respiratory behaviour and breathing patterns that resemble clinically recognised features of RD in term infants.
RESUMEN
BACKGROUND: During stabilisation of preterm infants at birth, a face mask is used to provide respiratory support. However, application of these masks may activate cutaneous stretch receptors of the trigeminal nerve, causing apnoea and bradycardia. This study investigated the amount of force exerted on the face mask during non-invasive ventilation of preterm infants at birth and whether the amount of exerted force is associated with apnoea and bradycardia. METHODS: A prospective observational study was performed in preterm infants born <32 weeks of gestation who were stabilised at birth. During the first 10 minutes of respiratory support, we measured breathing and heart rate as well as the amount of force exerted on a face mask using a custom-made pressure sensor placed on top of the face mask. RESULTS: Thirty infants were included (median (IQR) gestational age(GA) 28+3 (27+0-30+0) weeks, birthweight 1104 (878-1275) grams). The median exerted force measured was 297 (198-377) grams, ranging from 0 to 1455 grams. Significantly more force was exerted on the face mask during positive pressure ventilation when compared to CPAP (410 (256-556) vs 286 (190-373) grams, p = 0.009). In a binary logistic regression model, higher forces were associated with an increased risk of apnoea (OR = 1.607 (1.556-1.661), p < 0.001) and bradycardia (OR = 1.140 (1.102-1.180), p < 0.001) during the first 10 minutes of respiratory support at birth. CONCLUSION: During mask ventilation, the median exerted force on a face mask was 297 grams with a maximum of 1455 grams. Higher exerted forces were associated apnoea and bradycardia during the first 10 minutes of respiratory support at birth.
Asunto(s)
Apnea , Recien Nacido Prematuro , Recién Nacido , Humanos , Apnea/etiología , Máscaras/efectos adversos , Bradicardia/etiología , Respiración con Presión PositivaRESUMEN
Introduction: The transition to newborn life has typically been studied in intubated and mechanically ventilated newborn lambs delivered via caesarean section (CS) under general anaesthesia. As a result, little is known of the spontaneous breathing patterns in lambs at birth, particularly those at risk of developing respiratory distress (RD). We have developed a method for delivering spontaneously breathing near-term lambs to characterise their breathing patterns in the immediate newborn period. Methods: At 137-8 days gestation (2-3 days prior to delivery; term â¼147 days), fetal lambs (n = 7) were partially exteriorised for instrumentation (insertion of catheters and flow probes) before they were returned to the uterus. At 140 days, lambs were delivered via CS under light maternal sedation and spinal anaesthesia. Lambs were physically stimulated and when continuous breathing was established, the umbilical cord was clamped. Breathing patterns were assessed by measuring intrapleural and upper-tracheal pressures during the first four hours after birth. Results: Newborn lambs display significant heterogeneity in respiratory patterns in the immediate newborn period that change with time after birth. Seven distinct breathing patterns were identified including: (i) quiet (tidal) breathing, (ii) breathing during active periods, (iii) breathing during oral feeding, (iv) tachypnoea, (v) expiratory braking manoeuvres, (vi) expiratory pauses or holding, and (vii) step changes in ventilation. Conclusions: We have described normal respiratory behaviour in newborn lambs, in order to identify respiratory behaviours that are indicative of RD in term newborn infants.
RESUMEN
Several studies demonstrated an increase in time spent within target range when automated oxygen control (AOC) is used. However the effect on clinical outcome remains unclear. We compared clinical outcomes of preterm infants born before and after implementation of AOC as standard of care. In a retrospective pre-post implementation cohort study of outcomes for infants of 24-29 weeks gestational age receiving respiratory support before (2012-2015) and after (2015-2018) implementation of AOC as standard of care were compared. Outcomes of interest were mortality and complications of prematurity, number of ventilation days, and length of stay in the Neonatal Intensive Care Unit (NICU). A total of 588 infants were included (293 pre- vs 295 in the post-implementation cohort), with similar gestational age (27.8 weeks pre- vs 27.6 weeks post-implementation), birth weight (1033 grams vs 1035 grams) and other baseline characteristics. Mortality and rate of prematurity complications were not different between the groups. Length of stay in NICU was not different, but duration of invasive ventilation was shorter in infants who received AOC (6.4 ± 10.1 vs 4.7 ± 8.3, p = 0.029).Conclusion: In this pre-post comparison, the implementation of AOC did not lead to a change in mortality or morbidity during admission. What is Known: ⢠Prolonged and intermittent oxygen saturation deviations are associated with mortality and prematurity-related morbidities. ⢠Automated oxygen controllers can increase the time spent within oxygen saturation target range. What is New: ⢠Implementation of automated oxygen control as standard of care did not lead to a change in mortality or morbidity during admission. ⢠In the period after implementation of automated oxygen control, there was a shift toward more non-invasive ventilation.
Asunto(s)
Recien Nacido Prematuro , Oxígeno , Estudios de Cohortes , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Estudios RetrospectivosRESUMEN
AIM: To determine the time between adjustment of FiO2 at the oxygen blender and the desired FiO2 reaching the preterm infant during respiratory support at birth. METHODS: This observational study was performed using a Neopuff™ T-piece Resuscitator attached to either a test lung (during initial bench tests) or a face mask during the stabilization of infants at birth. FiO2 was titrated following resuscitation guidelines. The duration for the desired FiO2 to reach either the test lung or face mask was recorded, both with and without leakage. A respiratory function monitor was used to record FiO2 and amount of leak. RESULTS: In bench tests, the median (IQR) time taken to achieve a desired FiO2 was 34.2 (21.8-69.1) s. This duration was positively associated with the desired FiO2 difference, the direction of titration (upwards) and the occurrence of no leak (R2 0.863, F 65.016, p < 0.001). During stabilization of infants (median (IQR) gestational age 29+0 (28+2-30+0) weeks, birthweight 1290 (1240-1488) g), the duration (19.0 (0.0-57.0) s) required to reach a desired FiO2 was less, but still evident. In 27/55 (49%) titrations, the desired FiO2 was not achieved before the FiO2 levels were again changed. CONCLUSION: There is a clear delay before a desired FiO2 is achieved at the distal end of the T-piece resuscitator. This delay is clinically relevant as this delay could easily lead to over- and under titration of oxygen, which might result in an increased risk for both hypoxia and hyperoxia.
Asunto(s)
Consumo de Oxígeno/fisiología , Respiración con Presión Positiva/métodos , Resucitación/métodos , Humanos , Hiperoxia/prevención & control , Hipoxia/prevención & control , Recién Nacido , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Cuidado Intensivo Neonatal , Modelos Lineales , Factores de TiempoRESUMEN
OBJECTIVE: To evaluate the relation between Hb levels and the size of the placental anastomoses. METHODS: We performed a retrospective review of all uncomplicated MC twins delivered vaginally at our center from 2002 to 2017. Hb levels at birth and on day 2 were retrieved. All MC placentas were routinely injected with colored dye and high-resolution pictures were taken for computer-based analysis. We measured the size of arterio-arterial (AA) and veno-venous (VV) anastomoses as well as the total venous size, defined as the sum of the diameter of first generation of placental veins within 5â¯cm of each cord insertion. We assessed the relation between Hb levels and placental angioarchitecture. RESULTS: A total of 170â¯MC twin pairs were analyzed. Median Hb level in twin 1 was significantly lower than that in twin 2 both at birth (16.0 versus 17.4â¯g/dl, Pâ¯=â¯0.02) and on day 2 (14.6 versus 18.1â¯g/dl, Pâ¯=â¯0.000000188). Inter-twin Hb difference on day 2 was positively correlated with the size of AA anastomoses (Spearman râ¯=â¯0.25, 95% CI 0.04-0.43, Pâ¯=â¯0.0161). The diameter of AA anastomoses was positively related to the total size of veins connecting to AA anastomoses in the placental territory of twin 2 (Spearman râ¯=â¯0.55, 95% CI 0.41-0.66, Pâ¯=â¯0.0001). DISCUSSION: MC twins with larger AA anastomoses have higher Hb differences at birth. Higher Hb levels in second born twins may partly be due to increased placento-fetal transfusion through larger placental vessels.
Asunto(s)
Hemoglobinas/metabolismo , Recién Nacido/sangre , Placenta/irrigación sanguínea , Gemelización Monocigótica , Gemelos Monocigóticos , Femenino , Humanos , Embarazo , Estudios RetrospectivosRESUMEN
OBJECTIVE: To evaluate the effect of implementing automated oxygen control as routine care in maintaining oxygen saturation (SpO2) within target range in preterm infants. METHODS: Infants <30â weeks gestation in Leiden University Medical Centre before and after the implementation of automated oxygen control were compared. The percentage of time spent with SpO2 within and outside the target range (90-95%) was calculated. SpO2 values were collected every minute and included for analysis when infants received extra oxygen. RESULTS: In a period of 9â months, 42 preterm infants (21 manual, 21 automated) were studied. In the automated period, the median (IQR) time spent with SpO2 within target range increased (manual vs automated: 48.4 (41.5-56.4)% vs 61.9 (48.5-72.3)%; p<0.01) and time SpO2 >95% decreased (41.9 (30.6-49.4)% vs 19.3 (11.5-24.5)%; p<0.001). The time SpO2<90% increased (8.6 (7.2-11.7)% vs 15.1 (14.0-21.1)%; p<0.0001), while SpO2<80% was similar (1.1 (0.4-1.7)% vs 0.9 (0.5-2.1)%; ns). CONCLUSIONS: During oxygen therapy, preterm infants spent more time within the SpO2 target range after implementation of automated oxygen control, with a significant reduction in hyperoxaemia, but not hypoxaemia.
Asunto(s)
Monitoreo Fisiológico , Oximetría , Oxígeno/administración & dosificación , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Intubación Intratraqueal , Ventilación no Invasiva , Oxígeno/sangre , Terapia por Inhalación de Oxígeno , Estudios ProspectivosRESUMEN
Thrombocytopenia is a common finding in small for gestational age (SGA) neonates and is thought to result from a unique pathophysiologic mechanism related to chronic intrauterine hypoxia. Our objective was to estimate the incidence and severity of early-onset thrombocytopenia in SGA neonates, and to identify risk factors for thrombocytopenia. We performed a retrospective cohort study of all consecutive SGA neonates admitted to our ward and a control group of appropriate for gestational age (AGA) neonates matched for gestational age at birth. Main outcome measures were incidence and severity of thrombocytopenia, hematological and clinical risk factors for thrombocytopenia, and bleeding. A total of 330 SGA and 330 AGA neonates were included, with a mean gestational age at birth of 32.9 ± 4 weeks. Thrombocytopenia (<150x10(9)/L) was found in 53% (176/329) of SGA neonates and 20% (66/330) of AGA neonates (relative risk (RR) 2.7, 95% confidence interval (CI) [2.1, 3.4]). Severe thrombocytopenia (21-50x10(9)/L) occurred in 25 neonates (8%) in the SGA and 2 neonates (1%) in the AGA group (RR 12.5, 95% CI [3.0, 52.5]). Platelet counts <20x10(9)/L were not recorded. Within the SGA group, lower gestational age at birth (p = <0.01) and erythroblastosis (p<0.01) were independently associated with a decrease in platelet count. Platelet count was positively correlated with birth weight centiles. In conclusion, early-onset thrombocytopenia is present in over 50% of SGA neonates and occurs 2.7 times as often as in AGA neonates. Thrombocytopenia is seldom severe and is independently associated with lower gestational age at birth and erythroblastosis.
Asunto(s)
Recién Nacido Pequeño para la Edad Gestacional/sangre , Trombocitopenia/epidemiología , Edad de Inicio , Peso al Nacer , Eritrocitos/metabolismo , Femenino , Hemorragia/complicaciones , Humanos , Recién Nacido , Masculino , Recuento de Plaquetas , Estudios Retrospectivos , Factores de Riesgo , Trombocitopenia/sangre , Trombocitopenia/complicacionesRESUMEN
BACKGROUND: Delayed umbilical cord clamping (DCC) affects the cardiopulmonary transition and blood volume in neonates immediately after birth. However, little is known of blood flow in the umbilical vessels immediately after birth during DCC. The objective is to describe the duration and patterns of blood flow through the umbilical vessels during DCC. METHODS: Arterial and venous umbilical blood flow was measured during DCC using Doppler ultrasound in uncomplicated term vaginal deliveries. Immediately after birth, the probe was placed in the middle of the umbilical cord, pattern and duration of flow in vein and arteries were evaluated until cord clamping. RESULTS: Thirty infants were studied. Venous flow: In 10% no flow was present, in 57% flow stopped at 4:34 (3:03-7:31) (median (IQR) min:sec) after birth, before the cord was clamped. In 33%, flow continued until cord clamping at 5:13 (2:56-9:15) min:sec. Initially, venous flow was intermittent, increasing markedly during large breaths or stopping and reversing during crying, but then became continuous. Arterial flow: In 17% no flow was present, in 40% flow stopped at 4:22 (2:29-7:17) min:sec, while cord pulsations were still palpable. In 43% flow continued until the cord was clamped at 5:16 (3:32-10:10) min:sec. Arterial flow was pulsatile, unidirectional towards placenta or bidirectional to/from placenta. In 40% flow became continuous towards placenta later on. CONCLUSIONS: During delayed umbilical cord clamping, venous and arterial umbilical flow occurs for longer than previously described. Net placental transfusion is probably the result of several factors of which breathing could play a major role. Umbilical flow is unrelated to cessation of pulsations.
Asunto(s)
Parto Obstétrico/métodos , Cordón Umbilical/irrigación sanguínea , Puntaje de Apgar , Peso al Nacer , Constricción , Femenino , Edad Gestacional , Humanos , Recién Nacido , Masculino , Proyectos Piloto , Circulación Placentaria/fisiología , Embarazo , Estudios Prospectivos , Flujo Pulsátil/fisiología , Ultrasonografía Doppler/métodos , Arterias Umbilicales/diagnóstico por imagen , Arterias Umbilicales/fisiología , Cordón Umbilical/diagnóstico por imagen , Venas Umbilicales/diagnóstico por imagen , Venas Umbilicales/fisiologíaRESUMEN
OBJECTIVE: Neonatal resuscitation is often retrospectively documented, which can lead to inaccuracy and incomplete recording of delivery room management. In this study, we assessed the accuracy and completeness of neonatal resuscitation documentation in our neonatal intensive care unit. METHODS: Recordings of physiological parameters and video data were performed in the delivery room and used to deduct the clinical condition of the infant, the interventions done and their effect on the infant's condition. The data from the recordings were compared with the documentation on neonatal stabilisation in the medical records (paper or digital). RESULTS: Recordings of 54 infants were compared with the documentation in their medical records. In 93% of the medical records delivery room management was documented. The clinical condition of the infant at birth was documented in 76% and 1â min Apgar scores in 98%. Respiratory support was correctly documented in 83%, heart rate in 37% and oxygen saturation in 13%. In 57% use of supplemental oxygen and its indication were correctly reported. Seven infants were intubated and this was correctly documented in 57%. Apgar scores were compared between the recordings and the medical records. At 1 min, 5 min and 10â min after birth the Apgar score, given by the researcher using the recordings, was similar to the scores in the medical records in 33%, 44% and 53%, respectively. CONCLUSIONS: Accurate and complete documentation of neonatal resuscitation continues to be a challenge. Recordings of physiological parameters and video imaging can improve documentation by providing detailed information.
Asunto(s)
Salas de Parto/normas , Auditoría Médica/normas , Registros Médicos/normas , Grabación en Video , Puntaje de Apgar , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Intubación Intratraqueal , Auditoría Médica/métodos , Monitoreo Fisiológico/métodos , Países Bajos , Terapia por Inhalación de Oxígeno , Respiración Artificial , Resucitación/normas , Estudios RetrospectivosRESUMEN
OBJECTIVE: To investigate the occurrence and duration of oxygen saturation (SpO2) ≥95%, after extra oxygen for apnoea, bradycardia, cyanosis (ABC), and the relation with the duration of bradycardia and/or SpO2 ≤80%. METHODS: All preterm infants <32 weeks' gestation supported with nasal continuous positive airway pressure (nCPAP) admitted to our centre were eligible for the study. We retrospectively identified all episodes of ABCs. In ABCs where oxygen supply was increased, duration and severity of bradycardia (<80â bpm), SpO2 ≤80%, SpO2 ≥95% and their correlation were investigated. RESULTS: In 56 infants, 257 ABCs occurred where oxygen supply was increased. SpO2 ≥95% occurred after 79% (202/257) of the ABCs, duration of extra oxygen supply was longer in ABCs with SpO2 ≥95% than without SpO2 ≥95% (median (IQR) 20 (8-80) vs 2 (2-3) min; p<0.001)). The duration of SpO2 ≥95% was longer than bradycardia and SpO2 ≤80% (median (IQR) 13 (4-30) vs 1 (1-1) vs 2 (1-2) min; p<0.001). SpO2 ≥95% lasted longer when infants were in ambient air than when oxygen was given before the ABC occurred (median (IQR)15 (5-38) min vs 6 (3-24) min; p<0.01). CONCLUSIONS: In preterm infants supported with nCPAP in the neonatal intensive care unit (NICU), SpO2 ≥95% frequently occurred when oxygen was increased for ABCs and lasted longer than the bradycardia and SpO2 ≤80%.
Asunto(s)
Apnea/terapia , Bradicardia/terapia , Hiperoxia/etiología , Hipoxia/terapia , Enfermedades del Prematuro/terapia , Terapia por Inhalación de Oxígeno/efectos adversos , Presión de las Vías Aéreas Positiva Contínua/métodos , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Unidades de Cuidado Intensivo Neonatal , Masculino , Oxígeno/sangre , Presión Parcial , Estudios Retrospectivos , Medición de Riesgo/métodosRESUMEN
UNLABELLED: Point-of-care functional neonatal echocardiography (fnECHO) is increasingly used to assess haemodynamic status or patency of the ductus arteriosus (PDA). In Australasia, 90 % of neonatal intensive care units (NICUs) practice point-of-care fnECHO. The Australian Society of Ultrasound Medicine offers a training certificate for fnECHO. In Europe, the use and indications of fnECHO and the extent of point-of-care fnECHO training and accreditation are unknown. We aimed to assess utilisation and training of fnECHO in Europe. For this, we conducted an email survey of 45 randomly chosen tertiary NICUs in 17 European countries. The recall rate was 89 % (n = 40). Neonatologists with skills in fnECHO worked in 29 NICUs (74 %), but paediatric cardiologists would routinely perform most fnECHOs. Twenty-four-hour echocardiography service was available in 31 NICUs (78 %). Indications for fnECHO included assessment of haemodynamic volume status (53 %), presence or absence of pulmonary hypertension of the neonate (55 %), indication for and effect of volume replacement therapy (58 %), PDA assessment and monitoring of PDA treatment (80 %). Teaching of fnECHO was offered to trainees in 22 NICUs (55 %). Teaching of fnECHO was provided by paediatric cardiologists (55 %) or by neonatologists (45 %). Only six (15 %) national colleges accredited fnECHO teaching courses. CONCLUSION: fnECHO is widely practiced by neonatologists across Europe for a broad range of clinical questions. However, there is a lack of formal training and accreditation of fnECHO skills. This could be addressed by designing a dedicated European fnECHO training programme and by agreeing on a common European certificate of fnECHO.
Asunto(s)
Cardiología/educación , Ecocardiografía/estadística & datos numéricos , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Neonatología/educación , Pediatría/educación , Sistemas de Atención de Punto/estadística & datos numéricos , Acreditación , Recolección de Datos , Ecocardiografía/normas , Europa (Continente) , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/organización & administración , Proyectos PilotoRESUMEN
BACKGROUND: Mask leak is a frequent problem during manual ventilation. Our aim was to investigate the effect of predefined leaks on delivered peak inflation pressure (PIP), positive end-expiratory pressure (PEEP) and tidal volume (V(t)) when using different neonatal manual ventilation devices. METHODS: A neonatal-lung model was ventilated at different respiratory rates (RRs, 40, 60, 80/min) using a mechanically operated self-inflating bag (SIB) and a manually operated T-piece resuscitator (PIP = 20 cm H(2)O, PEEP = 5 cm H(2)O). Four open tubes of different lengths, which produced up to 90% leak, were consecutively attached between the ventilation device and the lung model. A pneumotachograph was used to measure pressures, flow and volume. RESULTS: With increasing leak (0-90%) PIP and PEEP decreased significantly (p < 0.001) for both devices. Using the SIB, the mean ± SD PIP fell from 20.1 ± 0.3 to 15.9 ± 7 cm H(2)O and PEEP fell from 5.0 ± 0 to 0.3 ± 0.5 cm H(2)O, leading to an increased pressure difference (Δp); V(t) increased from 8.8 ± 0.7 to 11.1 ± 0.8 ml (p < 0.001). With increasing RRs, the leak-dependent changes were significantly lower (p < 0.001). Using the T-piece resuscitator, PIP dropped independent of RRs from 20.3 ± 0.5 to 18.5 ± 0.6 cm H(2)O and PEEP from 5.1 ± 0.4 to 4.0 ± 0 cm H(2)O, while Δp and V(t) did not differ significantly. CONCLUSION: The decrease in PIP and PEEP with increasing leak is RR dependent and distinctly higher when using an SIB compared to a T-piece device. In contrast to V(t) delivered with the SIB, V(t) delivered by the T-piece resuscitator was nearly constant even for leaks up to 90%.
Asunto(s)
Presión del Aire , Análisis de Falla de Equipo/métodos , Falla de Equipo , Respiración Artificial/instrumentación , Reanimación Cardiopulmonar/instrumentación , Simulación por Computador , Equipos y Suministros/normas , Humanos , Técnicas In Vitro , Recién Nacido , Insuflación/instrumentación , Pulmón/patología , Pulmón/fisiopatología , Modelos Anatómicos , Respiración con Presión Positiva , Respiración , Respiración Artificial/efectos adversos , Volumen de Ventilación Pulmonar/fisiologíaRESUMEN
BACKGROUND: Ventilator-induced lung injury has been recognized as a major contributing factor for bronchopulmonary dysplasia (BPD) in preterm infants. In the last decade, focus has shifted towards a more gentle respiratory approach. AIM: To evaluate whether guideline changes in respiratory management in the delivery room and the unit improved the incidence of BPD in very preterm infants. METHODS: Three cohorts of infants <30 weeks of gestation, born at the Leiden University Medical Center in the Netherlands in 1996-1997 (cohort '96), 2003-2004 (cohort '03) and 2008-2009 (cohort '08), were compared retrospectively. The major change was increasing use of continuous positive airway pressure in time, and monitoring the tidal volume during mechanical ventilation in cohort '08. The primary outcome was BPD at 36 weeks. RESULTS: The incidence of BPD did not change from 47% in cohort '96 to 55% in cohort '03 (n.s.), but decreased significantly to 37% in cohort '08 (cohort '96 vs. '08 and cohort '03 vs. '08: p < 0.01). We observed the same effect when only moderate and severe BPD were counted with 27% in cohort '96, 31% in cohort '03 and 14% in '08 (cohort '96 vs. '03: p = n.s., cohort '96 vs. '08: p < 0.01, cohort '03 vs. '08: p < 0.05). The mortality rate was not significantly different between the three cohorts. CONCLUSION: The incidence of BPD in our cohort of preterm infants has decreased during the last decade and could be due to the changes in respiratory management.
Asunto(s)
Enfermedades del Prematuro/terapia , Mejoramiento de la Calidad , Respiración Artificial/métodos , Respiración Artificial/tendencias , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Displasia Broncopulmonar/epidemiología , Displasia Broncopulmonar/etiología , Estudios de Cohortes , Femenino , Humanos , Incidencia , Recién Nacido , Recien Nacido Prematuro , Masculino , Guías de Práctica Clínica como Asunto , Embarazo , Mejoramiento de la Calidad/tendencias , Respiración Artificial/efectos adversos , Respiración Artificial/normas , Estudios Retrospectivos , Factores de Tiempo , Lesión Pulmonar Inducida por Ventilación Mecánica/congénito , Lesión Pulmonar Inducida por Ventilación Mecánica/epidemiologíaRESUMEN
Objective. To determine the incidence, management, complications, and outcome in neonates with thrombotic events. Study Design. We performed a retrospective study of all neonates with thrombotic events admitted to our neonatal intensive care unit from January 2004 to July 2010. Results. Thrombotic events were identified in 32 of 4734 neonates (0.7%). Seven neonates were managed expectantly and 25 neonates received anticoagulant treatment. Complete resolution of the clot within 3 months of age was found in 68% (17/25) of the treated and in 86% (6/7) of the nontreated neonates. Major complications due to anticoagulant therapy occurred in 3/25 cases (12%) and included severe hemorrhage (n = 2) and abscess at the injection site (n = 1). Conclusion. Complete or partial clot resolution in neonatal thrombosis occurred in both the treated group and nontreated group. Randomized controlled trials are warranted to determine the optimal management in neonatal thrombosis.
RESUMEN
BACKGROUND: Neonatal herpes simplex virus (HSV) is a rare disease associated with high mortality and morbidity rates. HSV infection can be subdivided into 3 clinical manifestations: isolated skin, eye and mouth (SEM) disease, central nervous system (CNS) disease and disseminated disease. Consensus guidelines for diagnostic and therapeutic management are not available. OBJECTIVES: To evaluate the diagnostic work-up and therapeutic management in neonates with suspected or proven HSV infection. STUDY DESIGN: Retrospective study of diagnostic and therapeutic management in all neonates with suspected HSV infection admitted to our neonatal nursery between January 2005 and July 2010. RESULTS: A total 53 neonates with suspected HSV infection were included in the study and classified as SEM disease (n=2), CNS disease (n=41) or disseminated disease (n=10). None of the included infants tested positive for HSV infection. Correct and complete diagnostic work-up was performed in only 11% (6/53) of the cases. All neonates were treated with intravenous acyclovir. CONCLUSIONS: None of the neonates with suspected HSV tested positive. Diagnostic management in neonates with suspected HSV infection was often improper and incomplete. Consensus guidelines to identify low-risk infants in whom HSV testing and acyclovir treatment is not warranted, are urgently needed.
Asunto(s)
Aciclovir/uso terapéutico , Antivirales/uso terapéutico , Herpes Simple/diagnóstico , Herpes Simple/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Simplexvirus/aislamiento & purificación , Aciclovir/administración & dosificación , Antivirales/administración & dosificación , Ecoencefalografía , Femenino , Herpes Simple/virología , Humanos , Recién Nacido , Masculino , Reacción en Cadena de la Polimerasa , Complicaciones Infecciosas del Embarazo/virología , Estudios Retrospectivos , Simplexvirus/genéticaRESUMEN
BACKGROUND: International neonatal resuscitation guidelines recommend assessing chest excursion when the heart rate is not improving. However, the accuracy in assessing 'adequate' chest excursion lacks objectivity. AIM: It was the aim of this study to test the accuracy in the assessment of 'adequate' chest excursion by measuring intra- and inter-observer variability of participants during simulated neonatal resuscitation. METHODS: Thirty-seven staff members (8 neonatologists, 8 registrars, 21 nurses) of the Neonatal Intensive Care Unit, Leiden University Medical Center, Leiden, The Netherlands, ventilated 2 different intubated, leak-free manikins at 2 attempts, each with a different compliance. Blinded to the manometer, participants could change the peak inflation pressure until chest movement was adequate according to their perception. Inflating pressures were recorded. RESULTS: According to the participants, a median (interquartile range) pressure of 18 cm H2O (16-22) at the first and 18 cm H2O (16-25) at the second attempt were needed to reach adequate chest excursion in the Laerdal manikin. The HAL manikin needed 26 cm H2O (19-31) and 24 cm H2O (22-33), respectively. The inter-observer coefficient of variance was 30% with the Laerdal manikin at both attempts, and 35 and 40% with the HAL manikin, respectively. The intra-observer coefficient of variance was 15% (8-23) with the Laerdal and 13% (9-20) with the HAL manikin. In both manikins and attempts, no significant differences in pressures and variances of pressures between the 3 groups were found. CONCLUSION: 'Adequate' chest excursion is a subjective parameter for guidance of appropriate ventilation during neonatal resuscitation.
Asunto(s)
Enfermedades del Recién Nacido/terapia , Resucitación/métodos , Resucitación/normas , Oscilación de la Pared Torácica/métodos , Oscilación de la Pared Torácica/normas , Competencia Clínica , Adhesión a Directriz/normas , Conocimientos, Actitudes y Práctica en Salud , Humanos , Recién Nacido , Maniquíes , Cuerpo Médico de Hospitales , Neonatología , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Resucitación/estadística & datos numéricos , Tórax , Ventiladores Mecánicos , Recursos HumanosRESUMEN
BACKGROUND: congenital infections are associated with a wide variety of clinical symptoms, including small for gestational age (SGA). AIMS: to determine the co-occurrence of SGA and congenital TORCH infections, as diagnosed by TORCH serologic tests and/or cytomegalovirus (CMV) urine culture. STUDY DESIGN: we performed a retrospective study of all neonates admitted to our neonatal intensive care unit from January 2004 to February 2010 in whom SGA was diagnosed and TORCH serologic tests and/or CMV urine cultures were performed. RESULTS: TORCH serologic tests (in neonatal or maternal serum) and/or a CMV urine culture were performed in 112 neonates with SGA. None of the neonates tested positive for Toxoplasma gondii, Rubella, and Herpes simplex virus. Positive CMV urine culture was detected in 2% (2/112) of neonates, but their CMV IgM titers were negative. CONCLUSIONS: the co-occurrence of TORCH congenital infection in infants with SGA is rare. Routine TORCH screening in neonates with isolated SGA does not seem warranted and should be limited to CMV urine cultures.
Asunto(s)
Infecciones por Citomegalovirus/diagnóstico , Citomegalovirus/crecimiento & desarrollo , Pruebas Diagnósticas de Rutina/métodos , Recién Nacido Pequeño para la Edad Gestacional , Urinálisis/métodos , Células Cultivadas , Infecciones por Citomegalovirus/sangre , Infecciones por Citomegalovirus/orina , Infecciones por Citomegalovirus/virología , Herpes Simple/sangre , Herpes Simple/congénito , Herpes Simple/diagnóstico , Humanos , Recién Nacido , Enfermedades del Recién Nacido/sangre , Enfermedades del Recién Nacido/diagnóstico , Enfermedades del Recién Nacido/orina , Recién Nacido Pequeño para la Edad Gestacional/sangre , Recién Nacido Pequeño para la Edad Gestacional/orina , Inutilidad Médica , Estudios Retrospectivos , Rubéola (Sarampión Alemán)/sangre , Rubéola (Sarampión Alemán)/congénito , Rubéola (Sarampión Alemán)/diagnóstico , Pruebas Serológicas/métodos , Toxoplasma/aislamiento & purificación , Toxoplasmosis Congénita/sangre , Toxoplasmosis Congénita/congénito , Toxoplasmosis Congénita/diagnóstico , Virología/métodosRESUMEN
Thromboembolic events in preterm neonates are increasingly being diagnosed due to the increasing use of umbilical catheters and central venous catheters. Whether thromboembolic events should be treated routinely with low-molecular-weight heparin (LMWH) is controversial and the optimal management is still not clear due to the lack of randomized controlled trials. Most importantly, knowledge about the safety of treatment with LMWH in neonates with thromboembolic events is very limited. We present a case of severe hemorrhage in a preterm neonate after LMWH treatment and summarize the scarce data reported in the literature.